Ovarian cancer (OC) exhibits the highest mortality rate among gynecological tumors, with platinum-based chemotherapy resistance representing a pervasive therapeutic challenge. MicroRNAs (miRNAs) critically influence platinum drug response through multifaceted mechanisms: modulating DNA damage repair pathways such as nucleotide excision repair, homologous recombination repair, non-homologous end joining, and mismatch repair; regulating apoptotic processes via the inhibitor of apoptosis proteins (IAPs) family and B-cell lymphoma-2 (Bcl-2) family proteins; and controlling intracellular platinum levels through copper transporters, adenosine triphosphate-binding cassette (ABC) transporters, and metallothioneins. This review synthesizes current evidence on miRNA-mediated platinum resistance in OC, providing mechanistic insights to inform future research and potential clinical applications for overcoming chemoresistance.